A federal appeals court has ruled that New York State must comply with a lower court’s order to begin immediately transferring thousands of people with mental illness in New York City out of large, institutional group homes and into their own homes and apartments, where they will continue to receive specialized treatment and services.

The decision by a two-judge panel of the United States Court of Appeals for the Second Circuit to lift a stay of the lower court order means that after seven years of litigation, the state must now hurriedly begin the process of developing and executing a plan to create at least 1,500 units of so-called supportive housing a year for the next three years at state expense.

“Certainly it’s a complicated and important process that hopefully won’t get bogged down in bureaucracy,” said Geoff Lieberman, executive director of the Coalition of Institutionalized Aged and Disabled, an organization of adult homes and nursing home residents. “We’re hoping that there are a good number of adult home residents who will be able to move over the next 6 to 12 months.”

A spokesman for Gov. David A. Paterson said the state, wrestling with severe budget deficits, was in the process of determining its next steps.

Last September, Judge Nicholas G. Garaufis of United States District Court in Brooklyn found that the state had violated the Americans With Disabilities Act by keeping approximately 4,300 people with mental illness isolated from the outside world in warehouselike conditions in more than two dozen privately run adult homes. The state pays the homes for their care.

Over the vehement objection of the state and the owners of the homes, Judge Garaufis issued a remedial plan in March.

The plan would give nearly all current and future adult home residents the opportunity to move into supported housing scattered throughout the boroughs, where they would live independently while also receiving assistance like case-management services and visits from psychiatrists and nurses.

The state, which argued that advocates for residents of adult homes had overestimated the demand for and underestimated the cost of supported housing, appealed the decision.

An appeals court judge granted a temporary stay of the lower court’s order, but the court lifted that stay on Wednesday even though the appeal has not been decided. That places the state under the watch of a court monitor to ensure compliance with the ruling in the months before the appeal is heard.

“The expectation under this order is that they will be moving at a fast clip, and housing should be created as this appeal is pending,” said Cliff Zucker, the executive director of Disability Advocates, the nonprofit legal services group that filed the lawsuit. “People are clamoring to leave adult homes and get into supported apartments.”

Maggie McQuillar, a resident of Harbor Terrace Adult Home and Assisted Living on Staten Island, was among those eager to move out of a shared bedroom and live on her own. “I’m a senior citizen with a disability, but I can take care of myself,” said Ms. McQuillar, 68, who said she had diabetes and bipolar disorder.

“I’d be better off in a studio or one-bedroom,” she said. “Once you get here, you sort of get stuck here.”

This CME activity was developed to be distributed on Medscape.
This activity is intended for psychiatrists.
There are no prerequisites for this educational activity.

Goal
Schizophrenia and schizoaffective disorder are psychotic disorders with overlapping symptomatology. Physicians can very easily issue the wrong diagnosis, ending in less than optimal treatment for the patient. Furthermore, treatment issues are also complicated in schizoaffective disorder, because these patients have often been included together with schizophrenia patients in clinical trials. There is a clear need to establish in the minds of physicians, caregivers, patients, and others the difference between the two disorders as well as prognosis and optimal treatment options for each.

Presenters:
Leslie Citrome, MD, MPH, Chair
Professor of Psychiatry, New York University School of Medicine, New York, New York, Chair

Go to site. Scroll down to bottom of page. Above “Disclaimer” is a light blue box and above blue box is “Contents of This CME Activity.” In the blue box, select title of presentation and a new window will open then press buttons. If you are not a pyschiatrist, skip section 1, “Pre-Activity Questionnaire” and section 6, “Post-Activity Questionnaire” or review questions and answers but do not submit.

For the past nine months, Charlie Rose, with co-host and NARSAD Scientific Council member Eric Kandel, M.D., has explored one of science’s final frontiers, the study of the human brain.

Don’t miss Episode 9: The Mentally Ill Brain, which will air on Tuesday, June 22nd. Scientific Council member, Jeffrey Lieberman, M.D., Chairman of the Department of Psychiatry at Columbia University is participating in this show.

“The Charlie Rose Brain Series explores one of sciences final frontiers, the study of the human brain.

Over the next year Charlie will interview the most knowledgeable scientists and researchers in hopes of illuminating a new topic of study. Each monthly episode will examine different subjects of the brain, including perception, social interaction, aging and creativity.

We will also look at scientific discovery and advances in technology, in the hope that someday terrible illnesses such as depression, schizophrenia, and Alzheimer’s will be history.

Our special colleague on this journey is Dr. Eric Kandel. He is a psychiatrist and neuroscientist and professor at Columbia University. He’s also affiliated with the Howard Hughes Medical Institute. He received the Nobel Prize in physiology or medicine in 2000 for his research into the biological mechanisms of learning and memory.”

Episodes 1-8 may be seen online at
http://www.charlierose.com/view/collection/10702

The use of certain psychotropic medications enhances an already high underlying risk for osteoporosis, according to several studies presented here at the American Psychiatric Association 2010 Annual Meeting.

Psychotropic agents have been linked to fractures and antidepressants have been associated with low bone mineral density (BMD). Studies presented at this meeting validate these earlier findings and suggest that many patients may already be at high risk for bone disease.

In a large study from Canada, osteoporosis was found to be associated with the use of selective serotonin reuptake inhibitors (SSRIs), mood stabilizers other than lithium, and benzodiazepines. Use of tricyclic antidepressants was protective, he reported.

Placebo response in clinical trials of antipsychotic medications is highly heterogeneous and has implications for the design of placebo-controlled trials, according to a meta-analysis presented at the American Psychiatric Association 2010 Annual Meeting.

“Placebo response is often observed in psychiatric randomized clinical trials, and it presents a challenge for psychopharmacologic drug development,” said principal study author Ofer Agid, MD, University of Toronto, Ontario, Canada, and the Centre for Addiction and Mental Health. “We found there are differences in the placebo response in studies. We tried to understand if there are predictors.”

A portable device that analyzes blood cell count using a single drop of capillary blood may improve initiation of, and treatment adherence to, clozapine in patients with treatment-resistant schizophrenia, new research suggests.

A small case series study presented here at the American Psychiatric Association (APA) 2010 Annual Meeting illustrates the potential utility of the device in the 20% to 30% of patients with schizophrenia who fail to respond to conventional antipsychotics.

Recently, a program officer in NIMH’s extramural basic science division asked a senior, well-respected, NIMH-supported investigator why he had not submitted any recent grant applications. The PI looked surprised and asked, “Does NIMH still support basic research? I thought we had to include a clinical population to even be considered for funding.”

NOT TRUE!

In fact, NIMH has always and will continue to support cutting edge basic science research. Our Division of Neuroscience and Basic Behavioral Science continues to be the largest of our five extramural divisions, representing roughly 40% of our extramural funding. Yes, we care about translation, but to build a translational bridge we will need a very strong foundation in basic science. This foundation will need to be multidisciplinary, integrating biology and psychology. It will need to look across species, identifying principles of brain-behavior organization. Most important, it will need to cross levels of analysis – from genetic to molecular, to cellular, to systems, to complex behaviors, to social context.

It seems obvious, but bears repeating, that understanding normal functioning of brain-behavior relationships is critical to providing insight into abnormal brain-behavior relationships. To discover the causes of psychiatric disorders and develop improved treatments and interventions, NIMH must demonstrate how interactions between genes, environment, experiences, and development contribute to the formation and function of brain circuits.

What specific areas need more focus for a multidisciplinary approach to brain and behavior? NIMH has long-standing and ever-evolving interests in the mechanisms underlying emotion, executive function, impulsivity, social cognition, and memory. Cross-cutting priorities include a focus on mechanisms of neurodevelopment and sex/gender differences. Similarly ripe and relevant areas of emphasis include the functional connectivity of brain networks, neural and behavioral plasticity.

Comparative studies that identify fundamental principles of behavioral biology across species (e.g. likely sources of individual variation, conserved mechanisms of plasticity, the epigenetic basis of sensitive periods of development) are likely to become the foundation for the translational bridge. And translation goes in both directions: the study of “model animals” (engineered with genetic insights from clinical studies) may prove more informative than “animal models” (which mimic aspects of clinical disorders).

So, how can you tell if your basic research project is suitable for NIMH funding? Not all basic science belongs at NIMH. There are exceptions, but most studies of primary sensory or motor systems, metabolic regulation, or healthy aging will be better served by other Institutes. Some exclusively behavioral or social science research that does not cross levels of analysis may be better served by NSF or by one of the new cross-NIH efforts, such as OppNet or the Science of Behavior Change. NIMH provides numerous resources for potential grant applicants. Good written references on this topic include: “Setting Priorities for Basic Brain & Behavioral Science Research at NIMH” (PDF file, 15 pages), and the Division on Neuroscience and Basic Behavioral Science web-site. The best resource is always your program officer!

What’s the bottom line? Because psychiatric diseases are often characterized by deficits in complex social behavior, affective regulation, and cognition, NIMH is interested in basic research that explores the mechanisms underlying these critical aspects of mental life. The core idea is this: if we can understand the brain mechanisms responsible for how we experience emotions, make decisions, or interact with others, then we will be in a better position to understand how psychiatric diseases rob people of these abilities. Thus, basic research is the first, critical step down the road toward new and better treatments, cures and, ultimately, prevention of these devastating diseases.

Soon after the first Surgeon General’s Report on Mental Health was published in 1999, a supplement entitled “Mental Health: Culture, Race, and Ethnicity” detailed what was known of the relationship between race and mental illness and mental health care in the United States. This supplement identified critical needs for further investigation into these relationships and for the provision of culturally sensitive mental health care. As noted in the report, health care must continually adapt to meet the needs of the ever-changing population that it serves. Mental health care has no exception from this requirement. While one of America’s greatest strengths is its racial and cultural diversity, this diversity produces complex mental health care issues due to the heterogeneity of the population to be served.

To study the cultural and racial influences on mental health, NIMH initiated the Collaborative Psychiatric Epidemiology Surveys (CPES), including the National Comorbidity Survey Replication (NCS-R), the National Survey of American Life (NSAL), and the National Latino and Asian American Study (NLAAS). The NCS-R was a nationally-representative survey of 9,282 individuals including face-to-face structured diagnostic interviews. The NSAL focused on black Americans, including 6,199 African Americans, Caribbean blacks, and white individuals. The NLAAS included interviews with 4,649 Latino and Asian Americans. Taken together, these studies yield an unprecedented map of mental illness in America. Among many intriguing findings, perhaps what is most striking are not the variations in prevalence but the variations in care. Thus, for mental illness in America, the challenge is health equity; that is, achieving equal and optimal health care for all populations.

To better understand the context of mental health inequities, the new NIMH Office for Research on Disparities and Global Mental Health recently convened a summit of leaders from academic and research centers, community organizations, and government agencies with expertise ranging from genetics, epidemiology, medical anthropology, and cultural neuroscience to psychiatric education, service delivery, and policies. In addition to making recommendations for research priorities, the group’s lively discussion also highlighted a need to rethink traditional study designs and measures. Some suggestions included focusing more on incidence and burden rather than prevalence; enhancing communication and engagement between researchers, community members, and clinicians, as well as between government agencies with similar goals; and developing a workforce capable of studying the complex, interdisciplinary nature of mental health inequities.

Clearly, there is much work that remains to be done in reducing and reversing disparities in mental health care. But the wealth of knowledge and innovation that currently exists in the mental health community is encouragement enough to be bold in our research undertakings and, together with our like-minded colleagues at other NIH institutes, SAMHSA, and AHRQ to strive towards closing the gap in mental health care.

After a 2-month period of public review and commentary, which garnered “unprecedented” response, the first phase of field trials testing some of the proposed diagnostic criteria changes to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are set to begin this summer.

Speaking at a press briefing here at the American Psychiatric Association (APA) 2010 Annual Meeting, DSM-5 Task Force chairman David J. Kupfer, MD, told reporters that the new manual appears to be on track for the target publish date of May 2013.
Dr. David J. Kupfer

On February 20, the APA released the long-awaited draft of the DSM-5 and posted it for public feedback on the DSM-5 Website (http://www.dsm5.org). “We provided an opportunity for individuals from all over the world to provide us with written commentary,” said Dr. Kupfer.

By April 20, when the APA closed the 10-week public review period, Dr. Kupfer said the DSM-5 Task Force, which includes 13 work groups representing different categories of psychiatric diagnoses, had received close to 10,000 written responses.

Spirit of Schizophrenics Anonymous Monthly Toll-free Conference Call A chance to discuss ideas and issues related to SA Meetings with other SA Leaders. First Wednesday of each month at 7:00PM Eastern The call in information:Read More

Schizophrenia CME Activities

Provided by
Albert Einstein College of Medicine of Yeshiva University
In collaboration with
Haymarket Medical Education
In partnership with
Schizophrenia and Related Disorders Alliance of America (SARDAA)*

Provided by
University of Cincinnati
In collaboration with
Haymarket Medical Education
In partnership with
Schizophrenia and Related Disorders Alliance of America (SARDAA)*

*Note: The opinions expressed in these educational activities are those of the faculty and do not necessarily represent the views of SARDAA.